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Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
What is an ectopic pregnancy?A fertilised ovum is implanted outside the uterine cavity.The rate of ectopic pregnancy is 1% of all pregnancies and is higher in IVF pregnancies.Heterotopic pregnancy (the coexistence of an ectopic pregnancy with an intrauterine pregnancy), is very rare (approximately 1 in 30,000 conceptions) but is also more common in IVF pregnancies.
SBA Questions
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
An ultrasound is performed on a 30-year-old woman who presented with lower abdominal pain and a dark brown vaginal discharge. This shows an intrauterine gestational sac with no obvious fetal pole but with a yolk sac and an inhomogeneous left adnexal mass measuring 40 mm in diameter and a small echoic fluid in the pouch of Douglas. A diagnosis of a heterotopic pregnancy is made from these findings. What would be the best approach to the management of this patient who is haemodynamically stable?Expectant managementHyperosmolar injection of the adnexal mass with potassium chlorideLaparoscopic surgical removalMethotrexate – local injection in the adnexal massMethotrexate – systemic
Pregnancy
Published in T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng, Richard Wing-Cheuk Wong, Hao Chen, Diagnostic Endometrial Pathology, 2019
T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng
The diagnosis of an extrauterine pregnancy is facilitated by transvaginal ultrasound, laparoscopy and hormonal assays. Nevertheless, the pathologist often is presented with uterine curettings in situations in which the location of the pregnancy is uncertain. The pathologist's task is to rule in an intrauterine gestation. The presence of chorionic villi, trophoblast or implantation site will rule in an intrauterine gestation, but the pathologist cannot exclude an ectopic pregnancy because there may be a concurrent ectopic pregnancy. The prevalence of heterotopic pregnancy is approximately 0.9:1000 in patients conceiving with assisted reproductive technologies16 and estimated to be as high as 1:2600 in all pregnancies.17
Successful hysteroscopic treatment of a cervical heterotopic pregnancy: case report and literature review
Published in Journal of Obstetrics and Gynaecology, 2020
Antonio Rubattu, Valentina Corda, Iside Derosas, Maria Carla Monni, Cristina Nocco, Ambra Iuculano, Giangavino Peppi, Nadia Rosas, Giovanni Ruiu, Giovanni Monni
The incidence of multiple pregnancies has increased with the incremented use of assisted reproductive techniques (Abusheikha et al. 2000; Martinelli et al. 2007). Intrauterine pregnancy coexisting with CP is an uncommon but a life-threatening form of heterotopic pregnancy. There are few reports in the literature about the treatment of heterotopic pregnancy under these circumstances (Tanos et al. 2018). Subsequently, there is no consensus for the ideal approach to the management of CP in either singleton or heterotopic gestations. Hysteroscopy was first used for the diagnosis of a CP (Roussis et al. 1992); however, hysteroscopic management of CP is limited to case reports following the failure of medical management with methotrexate or in combination with uterine artery embolisation (Tanos et al. 2018). The first successful treatment of CP by uterine resectoscope was reported in 1996 (Ash and Farrel 1996), while in 2003 Jozwiak et al. described a heterotopic CP successfully treated with hysteroscopic resection, preserving an intrauterine pregnancy (Jozwiak et al. 2003). More recently, a case report described uterine artery embolisation followed by the hysteroscopic removal of both cervical and intrauterine gestations in the first trimester (Subedi et al. 2016).
Natural conception resulting in a ruptured heterotopic pregnancy in a multiparous woman
Published in Baylor University Medical Center Proceedings, 2020
Vimal B. Shenoy, C. J. Buckley
In a natural pregnancy, the index of suspicion for heterotopic pregnancy is low, which may mislead the clinician to truncate bedside ultrasound evaluation. The current standard of practice for first-trimester ultrasonography includes evaluation of adnexa and cul-de-sac.3 While the incidence of heterotopic pregnancy is extremely low, the morbidity associated with a missed diagnosis of heterotopic pregnancy is significant.4 Diagnosis of the etiology of abdominal pain in pregnancy can be challenging given concern for effects of radiation coupled with anatomical and functional changes in pregnancy. Heterotopic pregnancy is usually diagnosed with transabdominal or transvaginal ultrasound. However, the diagnosis can be difficult even with use of transvaginal ultrasound.5 In the absence of first trimester ultrasonography, as in this case, the first presenting indication of heterotopic pregnancy can be abdominal pain or vaginal bleeding.
Frozen blastocyst transfer reduces incidence of ectopic pregnancy compared with fresh blastocyst transfer: a meta-analysis
Published in Gynecological Endocrinology, 2019
Two authors independently screened titles and abstracts of all searched studies and identified the studies that met the inclusion criteria before the final analysis. Controversial results were resolved by consensus. Study characteristics for all eligible studies were generated. The following data were collected from each study: the first author, publication year, study design, country of origin of the population studied, cryopreservation method, ET stage, EP inclusion criteria, the origin of frozen blastocysts, and the number of embryos transferred. EP was defined as an extrauterine gestational sac identified by vaginal ultrasound or by laparoscopy. Heterotopic pregnancy, simultaneous intrauterine, and extrauterine gestations were defined as EP. Heterotopic pregnancy was also grouped into EP in this study.